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Titolo:
Risks and benefits of screening for intracranial aneurysms in first-degreerelatives of patients with sporadic subarachnoid hemorrhage
Autore:
Raaymakers, TWM; Rinkel, GJE; van Gijn, J; Greebe, P; Algra, A; Buskens, E; Buys, PC; Ramos, LMP; Witkamp, TD; Mali, WPTM; Tulleken, CAF; Limburg, M; Gorissen, A; Vonk, CM; Bossuyt, PMM; Bonsel, GJ; Verbeeten, B; Hulsmans, FJ; Albrecht, KW;
Indirizzi:
Univ Utrecht Hosp, Dept Neurol, NL-3584 CX Utrecht, Netherlands Univ Utrecht Hosp Utrecht Netherlands NL-3584 CX CX Utrecht, Netherlands Julius Ctr Patient Oriented Res, Utrecht, Netherlands Julius Ctr Patient Oriented Res Utrecht Netherlands trecht, Netherlands Acad Med Ctr, Dept Neurosurg, Amsterdam, Netherlands Acad Med Ctr Amsterdam Netherlands pt Neurosurg, Amsterdam, Netherlands Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands Acad Med Ctr AmsterdamNetherlands Dept Radiol, Amsterdam, Netherlands Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands Acad Med Ctr AmsterdamNetherlands Dept Neurol, Amsterdam, Netherlands Acad Med Ctr, Dept Clin Epidemiol & Biostat, Amsterdam, Netherlands Acad Med Ctr Amsterdam Netherlands ol & Biostat, Amsterdam, Netherlands
Titolo Testata:
NEW ENGLAND JOURNAL OF MEDICINE
fascicolo: 18, volume: 341, anno: 1999,
pagine: 1344 - 1350
SICI:
0028-4793(19991028)341:18<1344:RABOSF>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
UNRUPTURED CEREBRAL ANEURYSMS; SACCULAR ANEURYSMS; NATURAL-HISTORY; MR-ANGIOGRAPHY; RUPTURE; SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
41
Recensione:
Indirizzi per estratti:
Indirizzo: Raaymakers, TWM Univ Utrecht Hosp, Dept Neurol, H2-128,Heidelberglaan 100,NL-3584 CX Utrecht, Netherlands Univ Utrecht Hosp H2-128,Heidelberglaan 100 Utrecht Netherlands NL-3584 CX
Citazione:
T.W.M. Raaymakers et al., "Risks and benefits of screening for intracranial aneurysms in first-degreerelatives of patients with sporadic subarachnoid hemorrhage", N ENG J MED, 341(18), 1999, pp. 1344-1350

Abstract

Background The first-degree relatives of patients who have subarachnoid hemorrhage from ruptured intracranial aneurysms are themselves at risk for subarachnoid hemorrhage. We studied the benefits and risks of screening for aneurysms in the first-degree relatives of patients with sporadic subarachnoid hemorrhage. Methods We screened 626 first-degree relatives (parents, siblings, or children) of 160 patients with sporadic subarachnoid hemorrhage, from a prospective series of 193 consecutive index patients. Magnetic resonance angiography was the screening tool, and conventional angiography was used as the reference test in subjects thought to have aneurysms. Six months after elective operation, outcome was assessed by means of the modified Rankin scale of neurologic function. This observational study design was combined with a decision-analysis model to estimate the effectiveness of screening. The efficiency of screening was defined by the number of relatives who needed to be screened in order to prevent one subarachnoid hemorrhage. Results Aneurysms were found in 25 of 626 first-degree relatives (4.0 percent; 95 percent confidence interval, 2.6 to 5.8 percent). Eighteen underwent surgery, which resulted in a decrease in function in 11 (disabling in 1). Five had medium-sized aneurysms that were 5 to 11 mm in diameter, 11 had small aneurysms that were less than 5 mm, and 2 had both small and medium-sized aneurysms. On average, surgery increased estimated life expectancy by 2.5 years for these 18 subjects (or by 0.9 month per person screened), at the expense of 19 years of decreased function per person. The number of relatives who would need to be screened in order to prevent 1 subarachnoid hemorrhage on a lifetime basis was 149, and 298 would have to be screened in order to prevent 1 fatal subarachnoid hemorrhage. Conclusions Implementation of a screening program for the first-degree relatives of patients with sporadic subarachnoid hemorrhage does not seem warranted at this time, since the resulting slight increase in life expectancy does not offset the risk of postoperative sequelae. (N Engl J Med 1999;341:1344-50. ) (C) 1999, Massachusetts Medical Society.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/07/20 alle ore 16:29:45